What is chronic migraine and how does it affect life?
Chronic migraine (CM) is a neurological disorder characterized by frequent and intense headaches that can significantly reduce quality of life. Although headache is the primary symptom, CM is often accompanied by other debilitating manifestations such as nausea, increased sensitivity to light and sound, as well as pronounced fatigue and weakness [7, 8]. Estimates suggest that migraine affects 14-15% of the global population and is associated with a high degree of disability [7].
Patients with chronic migraine may face missed work or school, reduced productivity, and impaired daily functioning [4]. The prolonged course of the disease and constant struggle with symptoms lead to significant physical and emotional exhaustion, making fatigue one of the key factors affecting overall well-being.
Accurate diagnosis and an individualized approach to treatment
Effective treatment of chronic migraine begins with an accurate diagnosis and a deep understanding of the patient's condition. It is important to collect a detailed medical history to identify potential triggers and comorbid conditions [3]. In the constantly evolving landscape of migraine treatment, an individualized approach is essential [6].
A key aspect is the partnership between physician and patient. Clinicians, whether general practitioners, neurologists, or headache specialists, must actively involve the patient in the decision-making process, discussing available treatment options, managing expectations, and jointly determining the most effective and appropriate strategy [6]. Such an approach promotes long-term cooperation and increases treatment adherence.
Modern pharmacological treatments for migraine
In recent years, many new drugs for treating migraine have appeared on the market, significantly expanding therapeutic options [6].
- Acute treatment medications: Among the new agents for aborting acute migraine attacks, rimegepant and lasmiditan stand out. A study comparing treatment persistence between these drugs demonstrated their efficacy in acute cases [1].
- Preventive therapy: For patients with chronic migraine, especially with frequent attacks, preventive therapy is critical. The goal of prevention is to reduce the frequency, intensity, and duration of attacks. However, as one clinical case shows, unrecognized medication-overuse headache (MOH) and psychosocial stressors can make migraine resistant to preventive treatment [5].
- Treatment persistence features: Treatment persistence, meaning the regular use of medications, is an important factor for success. Studies show that the proportion of patients continuing to take medications (such as rimegepant or lasmiditan) over 12 months can vary, which is taken into account when choosing therapy [1].
Managing comorbid factors and non-pharmacological approaches
The management of chronic migraine extends beyond medication therapy alone and requires a comprehensive approach:
- Medication-overuse headache (MOH): This is a condition where the excessive use of pain relievers to treat migraine attacks paradoxically leads to more frequent and severe headaches. Discontinuation of the overused medication (e.g., eletriptan) and subsequent stabilization with preventive treatment are key steps to achieving sustained remission [5].
- Psychosocial stressors: Stress and other psychosocial factors can exacerbate the course of chronic migraine. Incorporating behavioral strategies and physical therapy into the treatment plan can help restore control over the condition and functional stability [5].
- Traditional methods: In some cases, especially when traditional treatment proves ineffective, patients may turn to alternative methods. For example, in Unani medicine, chronic migraine (Shaqīqa Sawdāwiyya) is viewed as a condition caused by an imbalance of "black bile." Cases of successful application of classical Unani formulas and herbal poultices (Ḍimād) to relieve symptoms and reduce disability in chronic migraine have been described [7, 8].
The importance of a comprehensive approach and realistic expectations
Managing chronic migraine requires a comprehensive approach that includes not only pharmacological treatment but also behavioral changes, social support, and the elimination or avoidance of triggers [3]. The goal of treatment is not only to abort attacks but also to restore functionality, improve quality of life, and reduce the overall disease burden [3, 6].
It is important to discuss individual treatment goals and realistic expectations with the patient. Creating an environment where the clinician and patient make decisions together is the key to choosing the most effective and appropriate treatment [6].
Sources
- [1] A retrospective cohort study comparing treatment persistence between rimegepant and lasmiditan for the acute treatment of migraine in the US. https://pubmed.ncbi.nlm.nih.gov/42273779/
- [2] Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease: An Individual Participant Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/37847274/
- [3] Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. https://pubmed.ncbi.nlm.nih.gov/32776537/
- [4] A Review of Existing and New Treatments for the Management of Hand Eczema. https://pubmed.ncbi.nlm.nih.gov/37496489/
- [5] Chronic Migraine Resistance: A Case Report Highlights an Overlooked Factors in Family Medicine Clinics. https://pubmed.ncbi.nlm.nih.gov/42450884/
- [6] Clinician-Patient Dialogue About Preventive Chronic Migraine Treatment. https://pubmed.ncbi.nlm.nih.gov/32988278/
- [7] Management of Chronic Migraine Without Aura with Classical Unani Formulations: A Case Report. https://pubmed.ncbi.nlm.nih.gov/42360865/
- [8] Therapeutic evaluation of herbal poultice (Ḍimād) in the management of pain and disability of chronic migraine: A case report. https://pubmed.ncbi.nlm.nih.gov/42314279/
The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified medical specialist for an accurate diagnosis and an individualized treatment plan.